"Dax's Case" Autonomy and Paternalism

Format Publication ID Version Published
Case, Multimedia 785 1 April 21, 2008
University of Texas Medical School at Houston


This is one of the most graphic videos you will ever see. Many medical schools have used it in the past and it is a classic, but some have decided not to use it because they didn't feel their students were ready for it or would be able to deal with it. I have decided the best thing to do was to not introduce it until the third year, when students are better prepared. But it is still likely to be quite disturbing to many observers.
I show the first 38 minutes of the video, in order to do justice to the personal perspectives of all the people who were involved in the case. One of the most important assumptions of patient-centered ethics (and narrative ethics) is that one cannot do justice to a case without knowing all of the social, economic, religious, and psychological factors that may influence the process. In other words, a good decision depends on more than medical expertise.


Spike J. "Dax's Case" Autonomy and Paternalism. MedEdPORTAL; 2008. Available from: www.mededportal.org/publication/785

Educational Objectives

  1. To be able to identify and answer what is decision-making capacity?
  2. To be able to identify and answer do patients have the right to refuse treatment? Even when it is clearly beneficial?
  3. To be able to identify and answer what is paternalism, and when (if ever) is it justified?
  4. To be able to identify and answer what is Patient Autonomy and has Autonomy gone too far?


  • Paternalism, Treatment Refusal (MeSH), Dax's Case, Burns (MeSH), Jehovah's Witnesses (MeSH), Right to Refuse


  • Medical
    • Physical Medicine & Rehabilitation


  • Dental
    • Ethics

Competencies Addressed

  • Medical
    • Interpersonal & Communication Skills
    • Patient Care
    • Professionalism

Academic Focus

  • Clinical Sciences
    • Clinical Skills/Doctoring

Professional Interest

  • Medical Ethics
  • Professionalism

Intended Audience

  • Professional School
    • Medical Student
  • Professional School Post-Graduate Training
    • Fellow
    • Resident

Instructional Methods

  • Independent Study
  • Problem-based Learning

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